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A new vision of leadership is needed for the NHS in the UK

Posted by Phil Kenmore

Phil Kenmore

The departure of David Nicholson as chief executive of NHS England has raised some questions about what the remit and tasks are for this role in the future. The first question should be: “Is it still the chief executive of the NHS?”. Any candidate who thinks the answer to this is ‘yes’ should probably withdraw now.

The job is just not the same. Yes it is still the biggest role in a health system that spends c£110bn pa.  But it no longer holds an executive function leading the service. One of the most significant problems facing NHS England in its embryonic stages are the number of people in the organisation, the Department of Health, and amongst Politicians who have not yet understood that this is a fundamentally different job.

The single biggest challenge facing the role now is one of vision and culture. There is a need for the whole of the NHS to be re-energised around a compelling vision that has been lost in the drive to QIPP and the response to the Mid Staffordshire NHS Foundation Trust Public Inquiry. Linked to this is a dire need to shift the culture of the service to one that focuses more on patient care and is more connected to, and aligned with, public expectations of the type of service we expect in the 21st century.

As a commissioner, the levers for driving this cultural change are less direct but come directly from the role of NHS England in setting the tone of how services are led by patients; how changes are implemented and how organisations and individuals are held to account. This comes from the top. The link of course, and a challenge, is to get Department of Health and Politicians to also buy-in to this shift – and actually do it. Easy to say, much harder to stick to when the bedpan hits the floor…

The problem is that the role of NHS England chief executive will have less direct control than it has ever had before – with less immediate levers to pull to satisfy Political storms as it truly becomes a commissioner focused organisation. With a coalition struggling to retain any sense of togetherness and an election approaching in 2015: there a question whether this role is actually do-able. Will it be stymied by the buffeting of Political forces from creating any real change? Both the new chief executive and the NHS England Chair and Board will need to be strong enough to create ‘elbow room’ in which to operate as the driver of cultural change through commissioning. And importantly, the whole organisation will need to learn how to create enough vision and harmony with adolescent Clinical Commissioning Groups (CCGs) to actually leverage a real shift in the service.

In short the NHS is crying out for a new sense of visionary leadership and a champion who can drive a shift to a more positive culture, focused less on itself and more on patients and the communities it serves. I for one truly hope the service gets a leader of the calibre and courage to do this in the face of inevitable Political interference.



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